Individual
DR. MYUNG-SUP KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
952 SETON DR, CUMBERLAND, MD 21502-1950
(301) 777-3522
(301) 777-1902
Mailing address
PO BOX 808, CUMBERLAND, MD 21501-0808
(301) 724-1646
(301) 724-7429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D26261
MD
2085B0100X
Body Imaging Physician
D26261
MD
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
D26261
MD
2085N0700X
Neuroradiology Physician
D26261
MD
2085N0904X
Nuclear Radiology Physician
D26261
MD
2085R0202X
Diagnostic Radiology Physician
Primary
D26261
MD
2085R0204X
Vascular & Interventional Radiology Physician
D26261
MD
2085U0001X
Diagnostic Ultrasound Physician
D26261
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010496230
—
PA
01
—
001708869
MT ST BLUE SHIELD
WV
05
—
0117502000
—
WV
05
—
2001896000
—
WV
05
—
526991100
—
MD
01
—
J2480003
GHMSI
MD
01
—
J2490003
GHMSI
MD
01
—
S3660001
GHMSI
MD
Enumeration date
05/23/2005
Last updated
10/20/2021
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